Term Effects of Propranolol on Portal Pressure in Cirrhotic
Ana Maria Orban-Schiopu,
Coralia Roxana Popescu
Department of Internal
Medicine, University Hospital ELIAS, Bucharest
Bleeding from varices
is a very serious complication in cirrhotic patients, with a
mean mortality rate around 30%. If the portal vein pressure
is decreased by pharmacological therapy the varices will not
bleed and progressively decrease in size. The portal hypertension
in cirrhotic patients develops as a consequence of two mechanisms:
the increase of portal inflow and the increase of intrahepatic
resistance. The aim of our study was to find out if propranolol
can prevent the bleeding from esophageal varices and if it acts
by reducing the portal inflow due to splanchnic vasodilatation.
The study was initiated in 53 patients with portal hypertension,
of whom 14 were withdrawn because of adverse effects of propranolol.
Abdominal ultrasonography and Doppler of portal vein system
were performed in all subjects. The ultrasonographic parameters
were measured before and after a 3-year treatment with propranolol.
The patients also underwent endoscopy for evaluation of esophageal
varices; the endoscopy was repeated at the end-point of treatment.
We noted that propranolol reduced the portal blood inflow and
the size of esophageal varices, and that the incidence of hemorrhages
by variceal rupture was very low in these patients.
Propranolol - liver
cirrhosis - portal vein pressure - esophageal varices